Billing & Denial Prevention Analyst

Mary Free Bed Rehabilitation Hospital•Grand Rapids, MI

About The Position

The Billing & Denial Prevention Analyst ensures accurate, timely, and compliant billing for inpatient and outpatient services. The role applies knowledge of payer regulations and billing practices to optimize reimbursement, reduce denials, and support the organization’s financial health. Responsibilities span claims management, denial prevention and resolution, compliance and documentation, patient financial engagement, collaboration and training, and continuous improvement. The analyst works with patients, payers, Access and Patient Services teams, Revenue Cycle, clinical departments, and leadership.

Requirements

Associate degree or equivalent experience in healthcare administration.
At least 3 years of progressive experience in healthcare billing.
General experience with CPT coding and third-party billing requirements.
Analytical and communication skills to explain, interpret, and present data.
Strong organizational and time-management skills, with the ability to manage multiple priorities and meet deadlines.
Ability to collaborate across departments and with external payers.
Strong written and verbal communication skills for preparing appeals and interacting with patients and payers.
Proficiency with Microsoft Office Suite, especially Excel for data tracking and reporting.
Empathetic and professional approach to patient financial counseling and inquiries.

Nice To Haves

Certification as a Certified Professional Coder (CSC), Certified Coding Specialist-Professional (CCS-P), or Certified Medical Reimbursement Specialist (CMRS).
Three to five years of experience with rehabilitation hospitals, inpatient or outpatient billing, or specialty care.

Responsibilities

Submit accurate and timely insurance claims using billing software while complying with payer regulations and maximizing reimbursement.
Monitor and follow up on unpaid claims, interpret denial reasons, identify root causes, and pursue appeals with appropriate documentation.
Process insurance rejections and requests for additional information, such as medical records and invoices.
Analyze denial trends, identify systemic issues, and recommend process improvements to leadership.
Prepare and submit written rationales for claim reconsideration requests.
Track and report denial activity in centralized systems.
Follow HIPAA and payer and governmental regulations to protect patient privacy and maintain compliance.
Review clinician notes and clinical documentation for completeness and accuracy to support compliant billing and minimize audit risk.
Research and communicate billing regulation changes to leadership.
Explain patient balances, offer payment options, and connect patients with financial assistance programs.
Engage patients regarding outstanding balances before collections and respond to inquiries by phone and email professionally and empathetically.
Partner with Access and Patient Services teams to identify training needs and improve front-end billing accuracy.
Collaborate across Revenue Cycle and clinical departments to resolve claim issues and improve interdepartmental efficiency.
Develop and maintain relationships with key payers to reduce accounts receivable days and improve revenue cycle performance.
Identify workflow efficiencies and participate in process redesigns to support departmental financial goals.
Perform other duties as assigned.
Demonstrate excellent customer service and standards of behavior, and encourage, coach, and monitor those standards in team members.
Promote teamwork and direct communication with coworkers and handle confidential information discreetly and sensitively.
Identify problems and seek solutions, promote patient and family satisfaction, and participate in departmental customer-service monitoring and reporting.